Drive-through diagnostic testing?

A story in the UK press on 21 November 2017, Cancer tests in supermarket car parks in bid to boost detection rates, elicited the comment from Diaceutics of “Now that’s progress!” Our vision is that better testing leads to better patient outcomes and earlier diagnosis in the patient journey is a big part of that. The article also stimulated an animated discussion on public health policy. This story described an NHS (UK) pilot scheme in which smokers and ex-smokers were invited to a mobile clinic at a local shopping centre. Those showing recognized symptoms of lung disease were invited to undergo an immediate CT scan. The scheme “quadrupled the number of cases of lung cancer detected at stage one or two, when it is more likely to be curable.” The NHS has plans for further easy access and home diagnostic testing to improve its cancer survival rates. But is this the way to go?

A Diaceutics team member who had recently attended the Lung Cancer Congress in Barcelona described how participants had been given a mobile app to vote on whether or not population screening is necessary. Even though participation was not particularly high, most doctors and pathologists in the room voted ‘no’. One issue was the radiation encountered in these screening programs. Another was the effects of suddenly learning that your symptoms need further investigation. The general consensus was that although screening is beneficial, it would be more cost-effective to invest in primary prevention and stop people smoking in the first place or help them quit. What concerned our colleague, however, was that molecular testing for targeted patients was not a consideration in the discussion, which we at Diaceutics believe should be high priority.

Another colleague was worried that easy-to-access diagnostic testing or public health screening initiatives such as this one can come about through political pressure, or the appearance of doing something rather than nothing. However, these programs may actually undermine clinical effectiveness, as could be the issue with some aspects of breast cancer screening, where the routine screening of all women over a certain age, rather than women of any age with a specific genetic risk, can create overdiagnosis of a relatively benign condition such as ductal hyperplasia. A worse outcome would be if a poorly-planned or executed screening initiative takes funding away from primary care initiatives. Lung cancer is not just the preserve of people with a smoking history. Will those without risk factors miss out on walk-up testing?

Whatever the reaction, this pilot scheme can be viewed as a step forward in giving patients much earlier access to diagnostic tests that can set the course to the right targeted treatment or highlight any susceptibility for a particular disease. Diagnostic testing, with the added benefit of being free from side effects, is working its way down the chain towards the people that matter – the patients – something we at Diaceutics are happy to endorse.